Non-routine discharge disposition is associated with post-discharge complications and 30-day readmissions following craniotomy for brain tumor resection.

Abstract

Several studies have reported an association between high-volume brain tumor centers and greater rates of routine discharge disposition in the context of better outcomes. However, the relationship between in-hospital complications, discharge destination, and postoperative adverse events (AEs) remains unexplored. The purpose of this study was thus to use a large, prospectively collected database to examine the association between discharge destination, post-discharge complications, readmissions, and reoperations among patients undergoing craniotomy for brain tumor. The 2011-2014 National Surgical Quality Improvement (NSQIP) database was employed to identify all adult patients who underwent a craniotomy for brain tumor resection. Demographics, comorbidities, and perioperative variables were collected for each patient. Univariate statistics with subsequent binary logistic regression analyses were used to explore the relationship between these perioperative factors and postoperative events, including major post-discharge complications, minor post-discharge AEs, readmissions, and return to the operating room (ROR). Significant variables such as demographics, comorbidities, operative time, body mass index, ASA classification and pre-discharge complications were controlled for in each model. Of the 14,854 patients identified, 11,409 (77.9%) were discharged home. After controlling for comorbidities and in-hospital AEs, discharge to skilled rehabilitation was an independent predictor of major post-discharge complications (OR 1.74, 95% CI 1.31-2.30, p < 0.001), minor post-discharge events (OR 1.60, 95% CI 1.07-2.41, p = 0.024), and ROR (OR 1.68, 95% CI 1.27-2.22, p < 0.001). Discharge to a care facility was predictive of major complications (OR 1.51, 95% CI 1.04-2.19, p = 0.030) and ROR (OR 2.02, 95% CI 1.46-2.80, p < 0.001). These factors may be considered in discharge planning and further outcomes studies for patients undergoing resection.